Is It Safe to Bring Ebola Victims to the U.S.?

byMaggie Fox

Medical staff working with Medecins sans Frontieres (MSF) prepare to bring food to patients kept in an isolation area at the MSF Ebola treatment center in Kailahun, Sierra Leone, July 20, 2014. Sierra Leone now has the highest number of Ebola cases, at 454, surpassing neighboring Guinea where the outbreak originated in February. Tommy Trenchard / Reuters

Is it dangerous to bring them here?

If handled properly, no, the Centers for Disease Control and Prevention says. “CDC has very well-established protocols in place to ensure the safe transport and care of patients with infectious diseases back to the United States,” the agency says. “These procedures cover the entire process — from patients leaving their bedside in a foreign country to their transport to an airport and boarding a non-commercial airplane equipped with a special transport isolation unit, to their arrival at a medical facility in the United States that is appropriately equipped and staffed to handle such cases.”

CDC director Dr. Thomas Frieden says any hospital with an intensive care unit and isolation facilities could handle a patient with Ebola. More restrictive facilities are only needed for airborne pathogens — that would include treatment areas with negative air pressure to handle, for instance, someone with a particularly pathogenic strain of pandemic influenza. Ebola doesn’t spread the way measles or even flu does.

How do you catch Ebola?

Ebola is spread through bodily fluids — vomit, stool and blood, especially. A single patient can infect several other people because these bodily fluids do carry a lot of the virus and someone who is violently ill with Ebola is going to be throwing up copiously and having a lot of diarrhea. And these fluids do remain infectious for a time after death, which is why people can get infected while washing a body in preparation for a funeral. The virus is not, however, carried through the air. You have to be close enough to have something splattered on you to get it.

In theory, Ebola could spread via a wet sneeze, although it’s not been demonstrated to have infected anyone this way. Again, you’d have to be fairly close — the virus doesn’t hang in small particles suspended in the air for a long time. Ebola also spreads via needle sticks and that’s one reason healthcare professionals are at such high risk.

What if someone who doesn’t know he's sick yet gets on a plane?

People do not transmit Ebola until they have begun showing symptoms, which include the usual flu-like symptoms such as fever, achiness and extreme fatigue, as well as vomiting and diarrhea. Ebola has been causing outbreaks since 1976 and doctors have a lot of experience with it. People who are starting to show symptoms of Ebola feel very ill and it would be very difficult for them to hide it. Aircraft personnel are trained to watch for anybody who gets sick on a flight and they will radio ahead to alert medical staff and, if necessary, divert to land at an airport with the right facilities to assess the patient.

How would we even know if they infected someone else before it’s too late?

Ebola has a fairly long incubation period — from anywhere between two and 21 days, and usually more like a week. That should give medical personnel enough time to track down people who may have, for instance, been sitting next to someone on a plane with Ebola. Again, you’d know it if you were exposed — the person would be very ill. CDC often tracks down people who have been with or near people with infectious diseases such as measles. This is different from influenza, a disease that gets transmitted before people begin showing symptoms and which patients can also spread after they start feeling better. That’s why new strains of influenza are considered potential pandemic agents while Ebola is not. Flu can spread quickly and silently. Ebola is not subtle.

What if the plane they are on crashed?

That would be a terrible thing for the people on board, but Ebola virus is not going to somehow escape into the atmosphere and spread, nor is it going to crawl along the ground and infect unsuspecting people.

Why bother treating people if there’s no cure?

There may not be a specific drug approved to treat Ebola, but doctors on the ground say supportive care does help. Giving saline and fever reducers has cut the mortality rate in the current West African outbreak, perhaps because patients don’t get severely dehydrated from the vomiting and diarrhea that Ebola can cause. Medecins Sans Frontieres (MSF or Doctors Without Borders) says in one clinic, early treatment lowered the mortality rate to 25 percent from about 60 percent.

Why bring them here instead of treating them in Africa?

That’s a decision that wasn’t made by anyone in the U.S. government, but by the two charities involved — Serving in Mission (SIM) and Samaritan’s Purse. Both said they wanted Dr. Kent Brantly, a doctor with Samaritan’s Purse, and Nancy Writebol, who works for SIM, to get the best possible care. Facilities in Liberia, as well as Sierra Leone and Guinea, are very limited, doctors, nurses and other workers are pulling long shifts and supplies are short. The care would be superior in the United States.

“We feel we owe them the right to receive the best medical care,” Dr Bruce Ribner, who heads the Infectious Diseases Division at Emory University Hospital, told a news conference. “I will be one of individuals who will be coming in direct contact with the patients. I have no concern for my health or the health of the other personnel or health workers.”

WHO and other groups say Ebola is out of control in West Africa. So why believe CDC when they say they can control it here?

Experts say Ebola is spreading in West Africa for several reasons, not least of which is that many of the people affected have never seen Ebola before, don't understand how it is spread and don't understand or trust Western medicine. People often avoid or even flee health care experts and facilities. There's a shortage of doctors and nurses, so many people are not even being diagnosed, and many of the worst affected placed have very little in the way of facilities to care for patients or to keep them clean so they don't infect others.

In contrast, the United States has modern facilities with well-equipped staff well trained in the basic hygiene that is needed to prevent the spread of any disease, including Ebola. People who are sick usually do not hesitate to seek care and if someone died from Ebola, their family members would be very unlikely to wash and bury the body on their own.

There's a track record on this — patients with SARS, MERS and Lassa fever have all shown up in the U.S. and have been treated successfully without infecting anyone else.